87181

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method

Medicare pricing data for 165 providers across 24 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method (HCPCS code 87181) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $4.63, but hospitals typically charge $15.34 — a 3.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$0.93

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $4.63, your out-of-pocket cost would be approximately $0.93. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$4.63
Average Hospital Charge
$15.34
Markup Ratio
3.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$15.34
Medicare Allowed$4.63
Medicare Payment$4.63

Hospitals charge 3.3x more than what Medicare allows for this procedure. Medicare actually pays $4.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$5$626139+1.5%
Hawaii$5$82134+0.4%
Illinois$5$564233+0.4%
Iowa$5$193237+0.4%
Kansas$5$492188+0.4%
Louisiana$5$71242+0.4%
Missouri$5$2021,399+0.4%
New Jersey$5$2542,420+0.4%
New York$5$3074,623+0.4%
North Dakota$5$272298+0.4%
Pennsylvania$5$55693+0.4%
Tennessee$5$30129+0.4%
Texas$5$4012639+0.4%
Virginia$5$593166+0.4%
Washington$5$311244+0.4%
Arizona$5$37321+0.4%
California$5$25161,294+0.4%
Florida$5$8725,287+0.2%
Minnesota$5$31222460.0%
Oregon$5$1431760.0%
Wisconsin$5$4071,1290.0%
Oklahoma$5$363140-0.9%
Ohio$4$136744-8.6%
Kentucky$4$4134-18.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber